P-57 Monitoring quality of life in PLWH using a patient reported outcomes (PRO) and screening tools for emotional and cognitive vulnerability
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Résumé
<h3>Background</h3> Recently, the achievements in treatments of people living with HIV (PLWH) have prolonged life expectancy, simplified clinical management and extended time interval between follow-up visits. Thus, some real-life needs may remain undetected during routine attendance, particularly those related to somatic, emotional and cognitive well-being. To optimize the retention-in-care of PLWH to intercept early signs of somatic, emotional and cognitive vulnerability and impairment, a screening program was conducted. <h3>Material and Methods</h3> All consecutive patients attending at the HIV/AIDS Unit of the San Gallicano Dermatological Institute in Rome, Italy, were administered: i) the Italian version of the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression vulnerability; ii) a symptoms scale (PRO), derived from the ISS-Quality of Life (ISSQoL) questionnaire, to measure frequency and intensity of symptoms during the previous month; iii) the Italian version of Montreal Cognitive Assessment (MoCA) to screen cognitive functions in seven different domains. <h3>Results</h3> From January to March 2024, 126 PLWH on ART were screened. Of these, 112 were men (88.9%) and 14 were women (11.1%), with a median age of 53 (IQR=43.25–58.75) and 47 years (IQR=38–58.25), respectively. Demographic and clinical characteristics are reported in table 1. Almost the totality of patients was virologically supressed and immunologically reconstituted. Overall, 35 (27.77%) and 18 (14.28%) reported anxiety and depression levels above the cut-off score, respectively. At the PRO, 64.8% of the patients declared fatigue at different level of intensity, 55.6% sleep disturbances, 51.6% pain, 34.4% decreased sexual interest, 32.5% mental confusion, and 26.1% erectile dysfunctions. Several reported symptoms were associated with emotional vulnerability for anxiety and depression, particularly fatigue, mental confusion and pain (table 2). Forty-five patients (35.7%) obtained a MoCA total score below the cut-off level of 26/30. Poor performances at MoCA screening were not significantly associated with the time of infection adjusted for age (AOR=1.53;95%CI=0.66–3.55; p=0.08) or with emotional vulnerability (Anx: p=0.41, Dep: p=0.59). Finally, fatigue and pain as PRO tended to be reported from patients on dolutegravir-based (p=0.04) and bictegravir regimen, respectively (p=0.004) (table 3). <h3>Conclusions</h3> A high proportion of PLWH reports recent somatic symptoms associated with a measurable vulnerability for anxiety and depression and over a third of the patients need a deeper neurocognitive assessment. Although these preliminary findings need to be confirmed at the clinical assessment and in a larger sample, they suggest the value of screening tools to intercept measurable QoL discomfort among viro-immunologically reconstituted PLWH.
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|---|---|---|
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